| NPI | 1972128031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 202301478) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 90361) |
| 207P00000X Emergency Medicine (Licence: GA 11897) | |
| Enumeration Date | 2020-06-14 |
| Last Update Date | 2023-07-30 |